Luận văn Thạc sĩ Shifts In MicromobilityRelated Trauma In The Age Of Vehicle Sharing The Epidemiology Of Head Injury

Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine January 2020 Shifts In Micromobility-Related Trauma In The Age Of Vehicle Sharing: The Epidemiology Of Head Injury Joshua Richard Feler Follow this and additional works at: https://elischolar.library.yale.edu/ymtdl Recommended Citation Feler, Joshua Richard, "Shifts In Micromobility-Related Trauma In The Age Of Vehicle Sharing: The Epidemiology Of Head Injury" (2020) Yale Medicine Thesis Digital Library 3898 https://elischolar.library.yale.edu/ymtdl/3898 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale For more information, please contact elischolar@yale.edu Shifts in micromobility-related trauma in the age of vehicle sharing: the epidemiology of head injury A Thesis Submitted to the Yale University School of Medicine in Partial Fulfillment of the Requirements for the Degree of Doctor of Medicine Joshua R Feler | Yale School of Medicine | Class of 2020 Advised by Jason Gerrard M.D Ph.D | Department of Neurosurgery Abstract Introduction National trends in rates of micromobility trauma Identifying epidemiological differences that may emerge from SMP characteristics 23 Behavioral differences potentiating high risk mechanisms 41 Conclusion 55 Bibliography 57 Appendices 67 Feler | Abstract Shared micromobility programs (SMPs) provide access to a distributed set of shared vehicles – mostly conventional bicycles, electronic bicycles, and electronic scooters – and are increasingly common in domestic and global cities, with riders completing an estimated 84 million trips using an SMP vehicle There is heterogeneity in these programs in size, vehicle types offered, and distribution model The impact of SMP introduction on the epidemiology of traumatic injury is largely unknown, and the relative safety of different shared vehicle types has not been evaluated; these effects are the subject of this study Considered as a whole, the annual number of traffic-related bicycle deaths in the United States has been increasing in the last decade The 30 most populous cities in 2010 were selected for closer analysis For each year in each city from 2010 to 2018, the crude rate of traffic-related bicycle deaths per-person and per-trip was calculated, and the year in which any SMP was introduced was identified Interrupted time-series analysis demonstrated that SMP introduction was not associated with changes to these rates but was associated with an increase in estimated number of bicycle trips National data suggest that rider demographics, and therefore population at risk, may shift with the availability of new vehicle types and SMPs Injured e-scooter riders, in particular, have near parity in the gender of injured riders, a stark contrast to the nearly to ratio of males in bicycle trauma, and SMP riders are disproportionately young adults The importance of these shifts was highlighted in analysis of the 2017 National Trauma Database®, which yielded 18,604 adult patients This analysis showed that older age, male gender, accident involving a motor vehicle, and failing to use a helmet were associated with more severe injuries and mortality It also demonstrated that the risk reduction afforded by helmets to females was less than the same for males in multivariate analysis These findings contextualize a review of studies of trauma involving motorized micromobility vehicles Finally, to explore mechanisms of differential injury by vehicle type, structured observations of riders of personal and shared vehicles were performed in San Francisco over months in the spring of 2019 In total, 4,472 riders were observed, approximately a fifth of whom Feler | used a shared vehicle Riders of shared vehicles were more likely to use a motorized vehicle including e-scooters and e-bicycles, but helmet use was lower among this cohort (37.3%), compared with riders of personal vehicles (84.6%) Use of a shared vehicle, an e-scooter, and a dockless shared vehicle were associated with decreased likelihood of helmet use Nonetheless, shared vehicle riders were equally likely to observe traffic regulations Riders of e-scooters were more likely to stop correctly at intersections but also more likely to ride on the sidewalk than riders of conventional bicycles (c-bicycles) and electronic bicycles (ebicycles) Given the popularity of SMPs and their success in augmenting urban public transport systems, some form of SMP will likely remain a fixture in urban environments for the foreseeable future The data collected here provide motivation for and guidance in developing safer SMPs and can potentially be used as agents of public health to tailor SMP characteristics to support safe practices and protect vulnerable road users Feler | Introduction The Evolution of Shared Micromobility Personal transportation is undergoing a revolution Where before choices were generally limited to automobiles, public transit, motorcycles, mopeds, bicycles, or walking, new technologies have brought an array of products facilitating movement through cities The miniaturization of electric motors and batteries—not to mention reliable disc-style brakes—has made possible the manufacture of electronic vehicles that enable riders to travel further, over more challenging terrain, and with heavier loads without corresponding increase in physical effort Widespread adoption of smartphones and GPS-enabled devices has facilitated the commercialization of shared vehicles deployed through SMPs that offer rental bicycles and scooters Distributed throughout urban environments, these have been touted as solutions to the ‘first-mile last-mile problem,’ filling large gaps between stations in a public transit network.1 Additionally, the surveillance economy2 has funded the rapid deployment of large fleets of cheaply available shared conventional bicycles (c-bicycles), electronic bicycles (e-bicycles), and electronic scooters (e-scooters) domestically and globally In 2012, the first public SMP in the United States of America was installed in Washington, D.C., and it offered 120 c-bicycles distributed among 10 stations.3 By the end of 2018, there were over 57,000 shared c- and e-bicycles in cities across the US, on which riders completed 36.5 million trips over the year.4 E-scooter rental programs grew even more rapidly The first shared e-scooter program was implemented in Santa Monica, CA in September of 2017, and by the end of 2018, 85,000 e-scooters were deployed in urban environments across the nation.5 Despite their newness, 38.4 million of the total 84 million trips by SMP riders in 2018 were on an e-scooter.4 SMPs differ in scale, distribution model, and vehicle type Some cities have fewer than 100 vehicles, while others have thousands At peak in Austin, TX, there were as 17,650 escooters from several companies deployed,6 about per 44 citizens There are two main distribution models: “station-based” SMPs require that vehicles be rented from docks Feler | distributed throughout a region, and “dock-less” SMPs allow their riders to start and end journeys at any point within a geographically defined area Common vehicle types include c-bicycles, e-bicycles, and e-scooters, although low-speed sit-on scooter models are also available in certain cities to provide greater accessibility for riders with physical disabilities.7,8 Selected characteristics of representative vehicles deployed by SMPs are given in Table 2.1 Figure 2.1: Shared C-bicycles, E-bicycles, and E-scooters Table 2.1: Characteristics of Typical Shared Vehicles Category Stand-on e-scooter Sit/stand e-scooter E-bicycle E-mopedb Provider Bird Ojo Jump Ford Scoot Governed Speeda 15 mph 20 mph 20 mph 18 mph 30 mph Weight 26.9 lbs 65 lbs 78 lbs 68 lbs 232 lbs Motor Power 250 W 500W 250 W 350 W 1400 W a Governed speed indicates the maximum speed at which the motor will continue to accelerate the vehicle Vehicles may travel at speeds greater than the governed speed (e.g riding downhill), but the motor will not contribute to maintaining this speed b E-mopeds are not generally not grouped within shared micromobility but are provided here for context Important differences may arise not just from the capacities of the vehicles but also from dependent shifts in the behaviors and demographics of riders For example, one-way trips and mixed-mode trips in which the use of a shared vehicle might comprise only a single leg of a journey are possible Although many examples of this trip pattern would be benign (e.g deciding to use a bicycle to return home from work on a sunny afternoon), others are not (e.g deciding the same while intoxicated) Similarly, motorized vehicles might attract riders that are either less physically capable, e.g the elderly, or less experienced As will be Feler | shown, these SMPs are accompanied by an interdependent mixture of shifting demographics and on-road behavior that may shift the epidemiology of traumatic bicycle injury The emergence of new vehicle types and ownership models has heralded much discussion of their impact on the urban environment including effects on public safety, challenges in regulating services, and data-reporting practices of companies; still there remains little published data describing the epidemiological effects of these programs on traumatic injury Rates of head injury are of particular interest as they are a common cause of morbidity and mortality among riders of bicycles and scooters, and helmets provide a protective effect to such injuries.9 Head injury may be the cause of death in as many as 75% of fatal bicycle accidents.10 Given their popularity and theoretical benefits to urban transport systems—specifically decongesting roads by shifting occupants out of automobiles11—SMPs will likely continue to spread through urban environments It is important that safe practices be identified to guide the expansions and innovations that shape the future of these programs Feler | National trends in rates of micromobility trauma Before discussing the relative safety of the different varieties of SMP, it must be assessed whether they can be implemented safely in any form As will be shown, the first SMP introduced in most cities is a bikeshare, and c-bicycles remain the dominant form of micromobility in general For that reason, this section assesses for changes to c-bicyclerelated mortality with the introduction of the first SMPs in large cities to explore their impact on mortality Bicycle-related trauma in the United States Nationally, rates of bicycle injury are rising From 1998 to 2013, there was a 28% increase in the number of injuries and a 120% increase in the number of hospitalizations attributed to bicycle accidents The odds of head injury increased by 10% over the same period.12 In 2018, the Center for Disease Control estimated 160,644 emergency room visits for trafficrelated bicycle injuries.13 Mortality has also risen from 727 to 857 deaths between 2004 and 2018.14 Compared to other developed nations, these numbers reflect considerably greater danger to domestic cyclists In 2010 in the United States, there were an estimated 10.3 deaths per million miles traveled, much greater than the 2.9 in Germany, 2.2 in the Netherlands, and 2.4 in Denmark (converted from reported per-kilometer rate).15 As can be seen in Figure 3.1, the increase is particularly prominent in urban environments while the total number of deaths in rural areas has remained fairly stable Feler | Figure 3.1: Traffic related Bicycle Fatalities in the United States 700 600 500 400 300 200 100 2002 2004 2006 Rural 2008 Urban 2010 2012 2014 Linear (Rural) 2016 2018 2020 Linear (Urban) N.B.: Diamonds indicate the year of introduction of bikeshare in the United States Data from NHTSA Fatal Accident Reporting System14 The impact of bikeshare on traumatic bicycle injury The impact of SMPs on population-level measures of safety is largely unknown A study of trauma registries from North American cities before and after the introduction of SMPs showed that the overall rate of trauma-team activations for bicycle accidents in cities fell by 28% after SMP introduction compared to an increase of 2% in control cities without a SMP over the same period The SMP cities were Montreal, Washington DC, Minneapolis, Boston, and Miami Beach; control cities were Vancouver, New York, Milwaukee, Seattle, and Los Angeles However, the odds of head injury increased by 30% in SMP cities but decreased by 6% in control cities, which the authors attributed to low utilization of helmets among SMP riders The authors were conservative in their interpretations: the introduction of SMP into a city increases the odds of head injury for injured bicyclists (aOR 1.3) Citing a lack of data describing rates of bicycle riding and rates of injury not causing a trauma activation, the authors not interpret their findings to mean that SMPs decrease the overall incidence of traumatic bicycle accidents.16 Moreover, this study predates the introduction of dockless vehicles and motorized vehicle to SMP fleets, limiting its generalizability to the present circumstance Feler | Finally, changes to the epidemiology of micromobility-associated trauma must be kept in context of traffic-related injury in general including pedestrian and motor vehicle trauma The goal for many of these programs is to decrease the overall rate of traffic-related injury and death by decreasing motor-vehicle congestion in urban centers For that reason, a careful balance must be struck between creating services that are appealing to potential riders and adequate regulation and safety features to ensure maximal rider safety Feler | 58 Bibliography Ma T, Liu C, Erdoğan S Bicycle Sharing and Public Transit: Does Capital Bikeshare Affect Metrorail Ridership in Washington, D.C.? Transp Res Rec 2015;2534(1):19 doi:10.3141/2534-01 Zuboff S A Digital Declaration FAZ.NET https://www.faz.net/1.3152525 Published September 15, 2014 Accessed December 2, 2019 About Company & History Capital Bikeshare http://www.capitalbikeshare.com/about Accessed November 13, 2019 NACTO 84 Million Trips Taken on Shared Bikes and Scooters Across the U.S in 2018 National Association of City Transportation Officials https://nacto.org/2019/04/17/84-million-trips-on-shared-bikes-and-scooters/ Published April 17, 2019 Accessed May 5, 2019 Bliss L The Electric Scooter War Is No Joke CityLab https://www.citylab.com/transportation/2018/04/the-micromobility-wars-areupon-us/558173/ Accessed November 13, 2019 Jones D Austin Stops Issuing New Licenses For Dockless Scooters And Bikes While It Conducts Review https://www.kut.org/post/austin-stops-issuing-new-licensesdockless-scooters-and-bikes-while-it-conducts-review Accessed November 15, 2019 OjO’s sit-down scooter-share service debuts in Austin, TX Smart Cities Dive https://www.smartcitiesdive.com/news/ojo-sit-down-scooter-share-service-austintexas/545593/ Accessed November 14, 2019 In bid for more accessibility, Portland OKs 725 electric scooters with seats BikePortland.org June 2019 https://bikeportland.org/2019/06/14/in-a-bid-formore-accessibility-portland-oks-725-electric-scooters-with-seats-301331 Accessed November 26, 2019 Olivier J, Creighton P Bicycle injuries and helmet use: a systematic review and metaanalysis Int J Epidemiol 2017;46(1):278-292 doi:10.1093/ije/dyw153 10 Thompson DC, Rivara F, Thompson R Helmets for preventing head and facial injuries in bicyclists Cochrane Database Syst Rev 1999;(4) doi:10.1002/14651858.CD001855 11 Fishman E, Washington S, Haworth N Bike share’s impact on car use: Evidence from the United States, Great Britain, and Australia Transp Res Part Transp Environ 2014;31:13-20 doi:10.1016/j.trd.2014.05.013 Feler | 59 12 Sanford T, McCulloch CE, Callcut RA, Carroll PR, Breyer BN Bicycle Trauma Injuries and Hospital Admissions in the United States, 1998-2013 JAMA 2015;314(9):947-949 doi:10.1001/jama.2015.8295 13 NonFatal Data | WISQARS | Injury Center | CDC https://www.cdc.gov/injury/wisqars/nonfatal.html Published September 16, 2019 Accessed November 26, 2019 14 NHTSA Fatal Accident Reporting System National Highway Traffic Safety Administration https://cdan.dot.gov/query Accessed November 14, 2019 15 Buehler R, Pucher J Trends in Walking and Cycling Safety: Recent Evidence From High-Income Countries, With a Focus on the United States and Germany Am J Public Health 2016;107(2):281-287 doi:10.2105/AJPH.2016.303546 16 Graves JM, Pless B, Moore L, Nathens AB, Hunte G, Rivara FP Public bicycle share programs and head injuries Am J Public Health 2014;104(8):e106-111 doi:10.2105/AJPH.2014.302012 17 Cowling K Net Effects of Bicycle Share Programs on Bike Safety Am J Public Health 2014;104(11):e6 doi:10.2105/AJPH.2014.302166 18 Bureau USC Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2018 https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=b kmk Accessed November 25, 2019 19 Bureau UC City and Town Intercensal Datasets: 2000-2010 Available at https://www.census.gov/data/datasets/time-series/demo/popest/intercensal-20002010-cities-and-towns.html Accessed November 25, 2019 20 Bureau UC American Community Survey Data The United States Census Bureau https://www.census.gov/programs-surveys/acs/data.html Accessed December 5, 2019 21 Gomez V, Maravall A Estimation, Prediction, and Interpolation for Nonstationary Series with the Kalman Filter J Am Stat Assoc 1994;89(426):611-624 doi:10.2307/2290864 22 Barnes G, Krizek K Estimating Bicycling Demand Transp Res Rec January 2005 doi:10.1177/0361198105193900106 23 Dennis J, Ramsay T, Turgeon AF, Zarychanski R Helmet legislation and admissions to hospital for cycling related head injuries in Canadian provinces and territories: interrupted time series analysis BMJ 2013;346:f2674 doi:10.1136/bmj.f2674 Feler | 60 24 GEBSKI V, ELLINGSON K, EDWARDS J, JERNIGAN J, KLEINBAUM D Modelling interrupted time series to evaluate prevention and control of infection in healthcare Epidemiol Infect 2012;140(12):2131-2141 25 Teschke K, Harris MA, Reynolds CCO, Shen H, Cripton PA, Winters M Exposurebased Traffic Accident Injury Rates by Mode of Travel in British Columbia Can J Public Health Rev Can Santé Publique 2013;104(1):e75-e79 26 Beck LF, Dellinger AM, O’Neil ME Motor Vehicle Accident Injury Rates by Mode of Travel, United States: Using Exposure-Based Methods to Quantify Differences Am J Epidemiol 2007;166(2):212-218 doi:10.1093/aje/kwm064 27 Martin E, Cohen A, Botha J, Shaheen S Bikesharing and Bicycle Safety Mineta Transp Inst Publ March 2016 https://scholarworks.sjsu.edu/mti_publications/207 28 Divvy Trips - Dashboard | City of Chicago | Data Portal https://data.cityofchicago.org/Transportation/Divvy-Trips-Dashboard/u94x-unre Accessed March 4, 2020 29 City Bike Daily Trip Averages By Month 2018 NYC Department of Transportation; 2018 https://www1.nyc.gov/html/dot/downloads/pdf/citi-bike-daily-tripaverages-by-month-2018.pdf Accessed March 3, 2020 30 Lyft Inc System Data | Bay Wheels Lyft https://www.lyft.com/bikes/baywheels/system-data Accessed February 5, 2020 31 McKenzie B Modes Less Traveled—Bicycling and Walking to Work in the United States: 2008–2012 :18 32 Elvik R, Bjørnskau T Safety-in-numbers: A systematic review and meta-analysis of evidence Saf Sci 2017;92:274-282 doi:10.1016/j.ssci.2015.07.017 33 Jacobsen PL Safety in numbers: more walkers and bicyclists, safer walking and bicycling Inj Prev 2003;9(3):205-209 doi:10.1136/ip.9.3.205 34 Teschke K, Koehoorn M, Shen H, Dennis J Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share BMJ Open 2015;5(11) doi:10.1136/bmjopen-2015-008052 35 Elvik R The non-linearity of risk and the promotion of environmentally sustainable transport Accid Anal Prev 2009;41(4):849-855 doi:10.1016/j.aap.2009.04.009 36 Campbell KB, Brakewood C Sharing riders: How bikesharing impacts bus ridership in New York City Transp Res Part Policy Pract 2017;100:264-282 doi:10.1016/j.tra.2017.04.017 Feler | 61 37 Graehler Jr M, Mucci RA, Erhardt GD Understanding the Recent Transit Ridership Decline in Major US Cities: Service Cuts or Emerging Modes? 98th Annu Meet Transp Res Board November 2018 https://www.researchgate.net/publication/330599129_Understanding_the_Recent _Transit_Ridership_Decline_in_Major_US_Cities_Service_Cuts_or_Emerging_ Modes Accessed February 6, 2020 38 Pucher J, Dill J, Handy S Infrastructure, programs, and policies to increase bicycling: An international review Prev Med 2010;50:S106-S125 doi:10.1016/j.ypmed.2009.07.028 39 Vision Zero Network Making our streets safer https://visionzeronetwork.org/ Accessed November 15, 2019 40 Mulvaney CA, Smith S, Watson MC, et al Cycling infrastructure for reducing cycling injuries in cyclists Cochrane Database Syst Rev 2015;(12) doi:10.1002/14651858.CD010415.pub2 41 Pedroso FE, Angriman F, Bellows AL, Taylor K Bicycle Use and Cyclist Safety Following Boston’s Bicycle Infrastructure Expansion, 2009–2012 Am J Public Health 2016;106(12):2171-2177 doi:10.2105/AJPH.2016.303454 42 League of American Bicyclists Bicycling & Walking in the United States: Benchmarking Report 2007 League of American Bicyclists; 2007 https://bikeleague.org/sites/default/files/2007BenchmarkingReport.pdf Accessed November 27, 2019 43 League of American Bicyclists Bicycling & Walking in the United States: Benchmarking Report 2010 League of American Bicyclists; 2010 https://bikeleague.org/sites/default/files/2010BenchmarkingReport.pdf Accessed November 27, 2019 44 League of American Bicyclists Bicycling & Walking in the United States: Benchmarking Report 2012 League of American Bicyclists; 2012 https://bikeleague.org/sites/default/files/2012BenchmarkingReport.pdf Accessed November 27, 2019 45 League of American Bicyclists Bicycling & Walking in the United States: Benchmarking Report 2014 League of American Bicyclists; 2014 https://bikeleague.org/sites/default/files/2014BenchmarkingReport.pdf Accessed November 27, 2019 46 League of American Bicyclists Bicycling & Walking in the United States: Benchmarking Report 2018 League of American Bicyclists; 2018:426 Feler | 62 47 Buck D, Buehler R, Happ P, Rawls B, Chung P, Borecki N Are Bikeshare Users Different from Regular Cyclists?: A First Look at Short-Term Users, Annual Members, and Area Cyclists in the Washington, D.C., Region Transp Res Rec J Transp Res Board 2013;2387(1):112-119 doi:10.3141/2387-13 48 Saenz M Electric scooters come to downtown El Paso KFOX https://kfoxtv.com/news/local/electric-scooters-come-to-downtown-el-paso Published April 5, 2019 Accessed December 2, 2019 49 Joseph B, Azim A, Haider AA, et al Bicycle helmets work when it matters the most Am J Surg 2017;213(2):413-417 doi:10.1016/j.amjsurg.2016.05.021 50 Schroeder T, Ault K The NEISS Sample (design and implementation) 1997 to Present :37 51 Graves JM, Whitehill JM, Hagel BE, Rivara FP Making the most of injury surveillance data: Using narrative text to identify exposure information in casecontrol studies Injury 2015;46(5):891-897 doi:10.1016/j.injury.2014.11.012 52 Bonyun M, Camden A, Macarthur C, Howard A Helmet use in BIXI cyclists in Toronto, Canada: an observational study BMJ Open 2012;2(3) doi:10.1136/bmjopen-2012-001049 53 Kraemer JD, Roffenbender JS, Anderko L Helmet Wearing Among Users of a Public Bicycle-Sharing Program in the District of Columbia and Comparable Riders on Personal Bicycles Am J Public Health 2012;102(8):e23-e25 doi:10.2105/AJPH.2012.300794 54 Chong S, Poulos R, Olivier J, Watson WL, Grzebieta R Relative injury severity among vulnerable non-motorised road users: Comparative analysis of injury arising from bicycle–motor vehicle and bicycle–pedestrian collisions Accid Anal Prev 2010;42(1):290-296 doi:10.1016/j.aap.2009.08.006 55 Boström L, Nilsson B A Review of Serious Injuries and Deaths from Bicycle Accidents in Sweden from 1987 to 1994 J Trauma Acute Care Surg 2001;50(5):900– 907 56 Rivara FP, Thompson DC, Thompson RS Epidemiology of bicycle injuries and risk factors for serious injury Inj Prev 1997;3(2):110-114 doi:10.1136/ip.3.2.110 57 Cripton PA, Shen H, Brubacher JR, et al Severity of urban cycling injuries and the relationship with personal, trip, route and accident characteristics: analyses using four severity metrics BMJ Open 2015;5(1) doi:10.1136/bmjopen-2014-006654 58 Moore DN, Schneider WH, Savolainen PT, Farzaneh M Mixed logit analysis of bicyclist injury severity resulting from motor vehicle accidents at intersection and Feler | 63 non-intersection locations doi:10.1016/j.aap.2010.09.015 Accid Anal Prev 2011;43(3):621-630 59 Misra A, Watkins K Modeling Cyclist Route Choice using Revealed Preference Data: An Age and Gender Perspective Transp Res Rec J Transp Res Board 2018;2672(3):145-154 doi:10.1177/0361198118798968 60 Prati G, Fraboni F, Angelis MD, Pietrantoni L Gender differences in cyclists’ accidents: an analysis of routinely recorded accident data Int J Inj Contr Saf Promot 2019;26(4):391-398 doi:10.1080/17457300.2019.1653930 61 Attewell RG, Glase K, McFadden M Bicycle helmet efficacy: a meta-analysis Accid Anal Prev 2001;33(3):345-352 doi:10.1016/S0001-4575(00)00048-8 62 Elvik R Publication bias and time-trend bias in meta-analysis of bicycle helmet efficacy: A re-analysis of Attewell, Glase and McFadden, 2001 Accid Anal Prev 2011;43(3):1245-1251 doi:10.1016/j.aap.2011.01.007 63 Carter PM, Flannagan CAC, Reed MP, Cunningham RM, Rupp JD Comparing the Effects of Age, BMI and Gender on Severe Injury (AIS 3+) in Motor-Vehicle Accidents Accid Anal Prev 2014;72:146-160 doi:10.1016/j.aap.2014.05.024 64 Crandall CS, Olson LM, Sklar DP Mortality Reduction with Air Bag and Seat Belt Use in Head-on Passenger Car Collisions Am J Epidemiol 2001;153(3):219-224 doi:10.1093/aje/153.3.219 65 Bose D, Segui-Gomez M, Crandall JR Vulnerability of Female Drivers Involved in Motor Vehicle Accidents: An Analysis of US Population at Risk Am J Public Health 2011;101(12):2368-2373 doi:10.2105/AJPH.2011.300275 66 Rivara FP, Astley SJ, Clarren SK, Thompson DC, Thompson RS Fit of bicycle safety helmets and risk of head injuries in children Inj Prev 1999;5(3):194-197 doi:10.1136/ip.5.3.194 67 Thai KT, McIntosh AS, Pang TY Bicycle Helmet Size, Adjustment, and Stability Traffic Inj Prev 2015;16(3):268-275 doi:10.1080/15389588.2014.931948 68 Lacko D, Huysmans T, Parizel PM, et al Evaluation of an anthropometric shape model of the human scalp Appl Ergon 2015;48:70-85 doi:10.1016/j.apergo.2014.11.008 69 Ellena T, Subic A, Mustafa H, Pang TY The Helmet Fit Index – An intelligent tool for fit assessment and design customisation Appl Ergon 2016;55:194-207 doi:10.1016/j.apergo.2016.02.008 Feler | 64 70 Kobayashi LM, Williams E, Brown CV, et al The e-merging e-pidemic of e-scooters Trauma Surg Acute Care Open 2019;4(1) doi:10.1136/tsaco-2019-000337 71 Trivedi TK, Liu C, Antonio ALM, et al Injuries Associated With Standing Electric Scooter Use JAMA Netw Open 2019;2(1):e187381-e187381 doi:10.1001/jamanetworkopen.2018.7381 72 Badeau A, Carman C, Newman M, Steenblik J, Carlson M, Madsen T Emergency department visits for electric scooter-related injuries after introduction of an urban rental program Am J Emerg Med 2019;37(8):1531-1533 doi:10.1016/j.ajem.2019.05.003 73 Which Helmet for Which Activity? CPSC.gov https://www.cpsc.gov/safetyeducation/safety-guides/sports-fitness-and-recreation-bicycles/which-helmetwhich-activity Published December 31, 2015 Accessed February 20, 2020 74 Siman-Tov M, Radomislensky I, Peleg K The casualties from electric bike and motorized scooter road accidents Traffic Inj Prev 2017;18(3):318-323 doi:10.1080/15389588.2016.1246723 75 de Guerre L, Sadiqi S, Leenen LPH, Oner CF, van Gaalen SM Injuries related to bicycle accidents: an epidemiological study in The Netherlands Eur J Trauma Emerg Surg October 2018 doi:10.1007/s00068-018-1033-5 76 Gross I, Weiss DJ, Eliasi E, Bala M, Hashavya S E-Bike-Related Trauma in Children and Adults J Emerg Med 2018;54(6):793-798 doi:10.1016/j.jemermed.2017.12.012 77 Tan AL, Chong CK, Hassan HB, et al The price of personal mobility: burden of injury and mortality from personal mobility devices in Singapore - a nationwide cohort study BMC Public Health 2019;19(1):880 doi:10.1186/s12889-019-72106 78 Schlaff CD, Sack KD, Elliott R-J, Rosner MK Early Experience with Electric Scooter Injuries Requiring Neurosurgical Evaluation in District of Columbia: A Case Series World Neurosurg 2019;132:202-207 doi:10.1016/j.wneu.2019.08.237 79 Kim J-K, Kim S, Ulfarsson GF, Porrello LA Bicyclist injury severities in bicycle– motor vehicle accidents Accid Anal Prev 2007;39(2):238-251 doi:10.1016/j.aap.2006.07.002 80 Rivara FP, Thompson DC, Thompson RS Epidemiology of bicycle injuries and risk factors for serious injury Inj Prev 1997;3(2):110-114 doi:10.1136/ip.3.2.110 Feler | 65 81 Parkin J, Meyers C The effect of cycle lanes on the proximity between motor traffic and cycle traffic Accid Anal Prev 2010;42(1):159-165 doi:10.1016/j.aap.2009.07.018 82 Morency P, Gauvin L, Plante C, Fournier M, Morency C Neighborhood Social Inequalities in Road Traffic Injuries: The Influence of Traffic Volume and Road Design Am J Public Health 2012;102(6):1112-1119 doi:10.2105/AJPH.2011.300528 83 Hamann C, Peek-Asa C On-road bicycle facilities and bicycle accidents in Iowa, 2007–2010 Accid Anal Prev 2013;56:103-109 doi:10.1016/j.aap.2012.12.031 84 Fyhri A, Fearnley N Effects of e-bikes on bicycle use and mode share Transp Res Part Transp Environ 2015;36:45-52 doi:10.1016/j.trd.2015.02.005 85 Haustein S, Møller M E-bike safety: Individual-level factors and incident characteristics J Transp Health 2016;3(3):386-394 doi:10.1016/j.jth.2016.07.001 86 Schleinitz K, Petzoldt T, Kröling S, Gehlert T, Mach S (E-)Cyclists running the red light – The influence of bicycle type and infrastructure characteristics on red light violations Accid Anal Prev 2019;122:99-107 doi:10.1016/j.aap.2018.10.002 87 Langford BC, Chen J, Cherry CR Risky riding: Naturalistic methods comparing safety behavior from conventional bicycle riders and electric bike riders Accid Anal Prev 2015;82:220-226 doi:10.1016/j.aap.2015.05.016 88 Wu C, Yao L, Zhang K The red-light running behavior of electric bike riders and cyclists at urban intersections in China: An observational study Accid Anal Prev 2012;49:186-192 doi:10.1016/j.aap.2011.06.001 89 Bai L, Liu P, Chen Y, Zhang X, Wang W Comparative Analysis of the Effects of Ebikes and Bicycles on Safety of Signalized Intersections Using Traffic Conflicts Technique In: ; 2013 https://trid.trb.org/view/1241081 Accessed November 25, 2019 90 Wolfe E, Arabian S, Salzler M, Bugaev N, Rabinovici R Bicyclist Safety Behaviors in an Urban Northeastern, United States City: An Observational Study J Trauma Nurs 2016;23(3):119-124 doi:10.1097/JTN.0000000000000202 91 Fu C, Guo Q Road traffic injuries in shared bicycle riders in China Lancet Public Health 2018;3(3):e111 doi:10.1016/S2468-2667(18)30024-0 92 Ethan D, Basch CH, Johnson GD, Hammond R, Chow CM, Varsos V An Analysis of Technology-Related Distracted Biking Behaviors and Helmet Use Among Cyclists in New York City J Community Health 2016;41(1):138-145 doi:10.1007/s10900-015-0079-0 Feler | 66 93 Fuller D, Gauvin L, Morency P, Kestens Y, Drouin L The impact of implementing a public bicycle share program on the likelihood of collisions and near misses in Montreal, Canada Prev Med 2013;57(6):920-924 doi:10.1016/j.ypmed.2013.05.028 94 Mooney SJ, Lee B, O’Connor AW Free-Floating Bikeshare and Helmet Use in Seattle, WA J Community Health 2019;44(3):577-579 doi:10.1007/s10900-01800599-1 95 Zanotto M, Winters ML Helmet Use Among Personal Bicycle Riders and Bike Share Users in Vancouver, BC Am J Prev Med 2017;53(4):465-472 doi:10.1016/j.amepre.2017.04.013 96 Basch CH, Ethan D, Rajan S, Samayoa-Kozlowsky S, Basch CE Helmet use among users of the Citi Bike bicycle-sharing program: a pilot study in New York City J Community Health 2014;39(3):503-507 doi:10.1007/s10900-013-9785-7 97 Fischer CM, Sanchez CE, Pittman M, et al Prevalence of Bicycle Helmet Use by Users of Public Bikeshare Programs Ann Emerg Med 2012;60(2):228-231 doi:10.1016/j.annemergmed.2012.03.018 98 Bonyun M, Camden A, Macarthur C, Howard A Helmet use in BIXI cyclists in Toronto, Canada: an observational study BMJ Open 2012;2(3) doi:10.1136/bmjopen-2012-001049 99 Basch CH, Ethan D, Rajan S, Samayoa-Kozlowsky S, Basch CE Helmet Use Among Users of the Citi Bike Bicycle-Sharing Program: A Pilot Study in New York City J Community Health 2014;39(3):503-507 doi:10.1007/s10900-013-9785-7 100 Mooney SJ, Lee B, O’Connor AW Free-Floating Bikeshare and Helmet Use in Seattle, WA J Community Health December 2018 doi:10.1007/s10900-01800599-1 101 Zanotto M, Winters ML Helmet Use Among Personal Bicycle Riders and Bike Share Users in Vancouver, BC Am J Prev Med 2017;53(4):465-472 doi:10.1016/j.amepre.2017.04.013 102 Reynolds CC, Harris MA, Teschke K, Cripton PA, Winters M The impact of transportation infrastructure on bicycling injuries and accidents: a review of the literature Environ Health 2009;8(1):47 doi:10.1186/1476-069X-8-47 103 Carlin JB, Taylor P, Nolan T A case-control study of child bicycle injuries: relationship of risk to exposure Accid Anal Prev 1995;27(6):839-844 doi:10.1016/0001-4575(95)00032-1 Feler | 67 104 Risk factors for bicycle-motor vehicle collisions at intersections J Safety Res 1996;27(3):195 doi:10.1016/0022-4375(96)82241-9 105 Schleinitz K, Petzoldt T, Gehlert T Risk compensation? The relationship between helmet use and cycling speed under naturalistic conditions J Safety Res 2018;67:165-171 doi:10.1016/j.jsr.2018.10.006 106 Kim J-K, Kim S, Ulfarsson GF, Porrello LA Bicyclist injury severities in bicycle– motor vehicle accidents Accid Anal Prev 2007;39(2):238-251 doi:10.1016/j.aap.2006.07.002 107 Joshi MS, Beckett K, Macfarlane A Cycle helmet wearing in teenagers health beliefs influence behaviour? Arch Dis Child 1994;71(6):536-539 108 Mitchell G, Tsao H, Randell T, Marks J, Mackay P Impact of electric scooters to a tertiary emergency department: 8-week review after implementation of a scooter share scheme Emerg Med Australas 2019;n/a(n/a) doi:10.1111/1742-6723.13356 109 Hayden S, Spillar R Dockless Electric Scooter-Related Injuries Study: Austin, Texas, September–November 2018.; 2019 http://www.austintexas.gov/edims/pio/document.cfm?id=318777 Accessed February 7, 2020 110 Hermon K, Capua T, Glatstein M, Scolnik D, Tavor O, Rimon A Pediatric Electric Bicycle Injuries: The Experience of a Large Urban Tertiary Care Pediatric Hospital Pediatr Emerg Care January 2018 doi:10.1097/pec.0000000000001395 111 Papoutsi S, Martinolli L, Braun CT, Exadaktylos AK E-bike injuries: experience from an urban emergency department-a retrospective study from Switzerland Emerg Med Int 2014;2014:850236 doi:10.1155/2014/850236 112 Du W, Yang J, Powis B, et al Epidemiological profile of hospitalised injuries among electric bicycle riders admitted to a rural hospital in Suzhou: a cross-sectional study Inj Prev 2014;20(2):128-133 doi:10.1136/injuryprev-2012-040618 Feler | 68 Appendices Appendix 1: Cities in FARS Regression 2010 Census Population Estimate SMP Introduction Date SMP Introduction Date Source New York city, New York 8,174,988 5/27/2013 http://citibikenyc.com/assets/pdf/12042_bike_share_launch.pdf Los Angeles city, California 3,792,820 7/7/2016 https://www.dailynews.com/2016/07/07/los-angelesfinally-has-a-bike-sharing-program-and-they-have-bigplans-for-it/ Chicago city, Illinois 2,695,624 6/28/2013 https://www.chicago.gov/city/en/depts/cdot/provdrs/bik e/news/2013/jul/chicago_welcomesdivvybikesharingsyste m.html Houston city, Texas 2,093,615 12/31/2013 https://www.houstontx.gov/planning/transportation/BC ycle.html Philadelphia city, Pennsylvania 1,526,009 4/23/2015 https://www.centreforpublicimpact.org/casestudy/philadelphias-indego-bike-sharing-system/ Phoenix city, Arizona 1,446,914 11/25/2014 https://www.azcentral.com/story/news/local/phoenix/20 14/11/25/phoenix-launches-grid-bike-share-systen/70094380/ San Antonio city, Texas 1,326,768 3/26/2011 https://www.mysanantonio.com/news/local_news/article /Bicycle-sharing-launched-in-S-A-1308451.php San Diego city, California 1,301,949 1/30/2015 https://www.kpbs.org/news/2015/jan/30/first-sandiego-bike-share-stations-open-business/ Dallas city, Texas 1,197,653 11/13/2014 https://www.dallasobserver.com/news/dallas-unveilsworlds-saddest-bike-sharing-program-7129476 San Jose city, California 952,060 8/29/2013 https://www.sfgate.com/bayarea/article/Bay-Area-BikeShare-program-about-to-begin-4769703.php Jacksonville city, Florida 821,764 4/5/2017 https://www.actionnewsjax.com/news/local/bikesharing-kiosks-coming-to-jacksonvillebeach/509385645 Indianapolis city (balance), Indiana 820,436 4/22/2014 http://www.ibj.com/bike-sharing-lined-up-for-culturaltrail/PARAMS/article/41876 San Francisco city, California 805,184 8/29/2013 https://www.sfgate.com/bay area/article/Bay-Area-BikeShare-program-about-tobegin-4769703.php Austin city, Texas 802,078 12/21/2013 http://www.kxan.com/news/local/austin/bike-shareprogram-to-launch-next-month Columbus city, Ohio 789,011 7/30/2013 http://www.columbusunderground.com/locations-setfor-cogo-bike-share-system-mid-summer-launchplanned-bw1 Fort Worth city, Texas 744,852 4/22/2013 http://www.fortworthbikesh aring.org/ Charlotte city, North Carolina 735,692 7/12/2012 http://pundithouse.com/2011/12/pedaling-push-fordnc-2012/ Detroit city, Michigan 713,885 5/23/2017 https://www.mlive.com/news/detroit/2017/05/mogo_lau nch.html El Paso city, Texas 648,254 9/16/2015 http://www.elpasotimes.com/news/ci_28612586/elpasos-bike-share-program-launching-september Memphis city, Tennessee 651,885 5/23/2018 Baltimore city, Maryland 620,862 10/28/2016 Boston city, Massachusetts 617,786 7/28/2011 https://www.bluebikes.com/about 608,666 10/13/2014 https://seattle.curbed.com/2014/10/14/10035888/seattle -celebrates-the-opening-of-its-firstever-bike-shareprogram 601,766 8/2/2008 https://www.capitalbikeshare.com/about 603,427 12/13/2013 http://www.newschannel5.com/story/19158880/mayordean-unveils-new-bike-sharing-program Denver city, Colorado 599,815 4/22/2010 https://www.fcgov.com/transportationplanning/pdf/fc_b ike_share_business_plan_final.pdf Louisville/Jefferson County metro government (balance), Kentucky 595,386 5/25/2017 http://wfpl.org/public-bike-share-could-roll-into-cityby-summer-officials-say/ City Seattle city, Washington Washington city, District of Columbia Nashville-Davidson metropolitan government (balance), Tennessee https://www.memphisdailynews.com/news/2017/jun/9/e xplore-bike-share-to-bring-600-bike-system-tomemphis/?utm_source=feedburner&utm_medium=feed &utm_campaign=Feed:+memphisdailynews/bbde+(The+ Memphis+Daily+News))In http://www.baltimoresun.com/news/maryland/baltimore -city/bs-md-ci-bike-share-contract-20160314story.html)(http://www.bizjournals.com/baltimore/news/ 2016/08/19/baltimores-first-bike-share-rentals-comingin.html?ana=fbk) Feler | 69 Milwaukee city, Wisconsin 594,511 12/31/2015 http://www.bizjournals.com/milwaukee/news/2014/08/0 6/milwaukee-bikeshare-program-expands-gets-a-nameof.html?page=all Portland city, Oregon 583,792 7/19/2016 http://www.oregonlive.com/commuting/index.ssf/2016/ 01/nike_to_sponsor_portlands_bike.html Las Vegas city, Nevada 584,509 9/30/2016 http://www.lasvegasnow.com/news/rtc-to-launch-bikerental-programdowntown)http://www.reviewjournal.com/news/lasvegas/rtc-oks-contract-bike-sharing-programdowntown-las-vegas Feler | 70 %Male ISS %Mortalty %StruckbyCar %Confirmed Intoxicated %ConfirmedHelmet HelmetEffect 51.90% - 18.5%minor,0% ICH 0% - 27% 46% Helmetreduceshead injuryOR.18 1pedestrianincluded 13(0) 44.5 61.50% - 76.9%bodyarea, 46.2%ICH(4tSAH, 7.70% 1tSAH+EDH,1 tSAH+SDH) - 5.5 15%headAIS>=3and nosurgery.16.5% concucssionw/oICH, 0.00% 18%ICH(4SDH,10 SAH,6IPH) - Neurosurgical Consults,United StatesofAmerica MultiCenter TraumaRegistry, UnitedStatesof America SingleCenter Emergency Department, UnitedStatesof America SingleCenter Emergency Department, UnitedStatesof America 228(26) 33.7 58.9% 38.2minor,2.2%ICH 0% 8.8% 5.20% NationalTrauma Registry,Israel 63(32) 18 77.8% 11.1%>15 36.5%area,4.8%TBI 0% 30.2% - - AdmittedPatients, Israel 47(17) 29.7 87.2% 2.10% 25% - 13% - significantlyreduces headanneckinjury, subduralbleeding, 1.70% intracerebralbleeding, skullfractures,and skullbasefractures 103(0) 190(9) 37.1 median29 65% 48%bodyarea,15% TBI 55% - Notes MeanAge ReportedHeadInjuries n(nchildren) 30.9a Setting 54(0) PubYear MajorHeadInjury:skullfracture orICH;MinorHeadInjury (closedheadinjury/concussion) 2019 - 2019 2019 16% 2019 - 2019 0% 2019 8%Major,12% Minor,